Medication Adherence in Hypertension: A Cluster Randomized Clinical Trial.

Data linkages between electronic health records and pharmacies have created opportunities for scalable assessment of medication adherence at the point of care.

电子健康记录与药房之间的数据链接为在护理点规模化评估药物依从性创造了机会。

Background

To test the effectiveness of a multicomponent intervention that identified patients with uncontrolled hypertension and medication nonadherence using linked electronic health record-pharmacy data combined with team-based care to address adherence barriers.

测试一种多组分干预措施的有效性，该措施通过结合电子健康记录和药房数据以及团队为基础的护理来识别未控制高血压和药物不依从的患者，并解决依从性障碍。

DESIGN, SETTING, AND PARTICIPANTS: TEAMLET (Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence) was a pragmatic, 2-arm, cluster randomized clinical trial conducted between October 2022 and November 2024 in 10 primary care sites in New York.

设计、环境和参与者：TEAMLET（利用电子健康记录技术和团队护理解决药物依从性问题）是一项实用的、两臂、群组随机临床试验，于2022年10月至2024年11月在纽约的10个初级保健场所进行。

The study included adults with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) less than 80%.

该研究纳入了患有未控制高血压且药物依从性低的成年人，定义为药物覆盖天数比例（PDC）小于80%。

Data analysis was performed from November 2024 to January 2025.

数据分析是从2024年11月到2025年1月进行的。

intervention

The intervention consisted of the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient.

干预措施包括以下几点：（1）在就诊时自动识别不遵医嘱的患者；（2）提示医疗助理筛查遵医行为的障碍；（3）临床决策支持系统提醒初级保健医生和护士注意遵医行为的障碍；以及（4）初级保健医生或护士与患者之间就遵医行为进行讨论。

The comparator was usual care.

对照组接受常规护理。

main_outcomes_and_measures

The primary outcome was change in PDC from baseline to 12 months.

主要结果是基线至12个月时PDC的变化。

Results

Among 1726 patients (mean [SD] age, 67.2 [13.9] years; 887 [51.4%] female), the mean (SD) baseline PDC was 33.2% (30.5%) overall (32.4% [30.4%] in the intervention group and 34.0% [30.6%] in the control group).

在1726名患者（平均[标准差]年龄为67.2[13.9]岁；887名[51.4%]为女性）中，整体基线PDC的平均值（标准差）为33.2%（30.5%）（干预组为32.4%[30.4%]，对照组为34.0%[30.6%]）。

The mean (SD) PDC at 12 months was 51.1% (39.5%) for the intervention group and 53.1% (39.6%) for the control group.

干预组12个月时的平均（标准差）PDC为51.1%（39.5%），对照组为53.1%（39.6%）。

No difference was found in the change in PDC from baseline to 12 months between the intervention and control groups (mean [SD] absolute change in PDC, 18.5 [41.1] vs 18.2 [40.9] percentage points, respectively; adjusted difference, -0.15 percentage point; 95% CI, -4.06 to 3.76 percentage points).

从基线到12个月，干预组和对照组在PDC变化上没有差异（平均[标准差]PDC绝对变化分别为18.5[41.1]和18.2[40.9]百分点；调整后差异为-0.15百分点；95%置信区间为-4.06到3.76百分点）。

Change in systolic blood pressure and patients who became adherent (PDC ≥80%) at 12 months were also similar between groups.

在12个月时，两组间收缩压的变化以及成为依从性良好（PDC≥80%）的患者数量也相似。

conclusions_and_relevance

In this pragmatic trial, an intervention that combined team-based primary care with automated identification of patients with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure.

在这项实用性试验中，结合团队基础的初级保健与自动化识别抗高血压药物不依从患者的干预措施，并未导致依从性或血压的改善。

trial_registration

ClinicalTrials.gov Identifier: NCT05349422.

临床试验注册号：NCT05349422。